Symptoms Tests & Treatment For Cervical Cancer
Cervical cancers are quite common in developing countries like India. And till recently, it was the most prevalent cancer found in the female population of India. The cervix is that part of the uterus between the body of the uterus and the vagina. Cancers of the cervix behave differently from the cancers of the body of the uterus.
Development of cervical cancer is closely linked to a virus known as Human Papilloma Virus (HPV). The main mode of transmission of HPV is through sexual contact. However, the chances of developing HPV infection is higher with the following:
- Multiple sexual partners
- Poor genital hygiene
- Repeated genital infections
While most HPV infections get cured on their own, in some cases they are persistent. The persistent infections lead to precancerous changes and in some cases cancer. The chances of developing cancer are much higher when the immunity of the person is reduced with conditions such as an HIV infection.
- Bleeding without menstrual periods
- Bleeding after sexual intercourse
- Persistent white discharge
- Chronic pelvic pain
- Also, a few patients can be asymptomatic
This is a test commonly performed to screen women for cervical cancer. It is recommended for all women after sexual intercourse has been initiated and is also usually a part of the annual health check for women. It is recommended that even women with a normal pap smear to repeat the checks once in three to five years.
Since the cervix is easily felt, what is usually done in a pap smear is that scrapings are taken with a spatula from the cervix and sent to the pathologist for examination under a microscope. The pathologist examines the smears and categorises the smears into either normal or instances where changes in HPV infection are present. The changes are further categorised in to mild, moderate or severe. In a few cases there may also be a presence of cervical cancer which may be detected.
Women with an abnormal pap smear test are advised to go in for colposcopy in which the gynaecologist examines the cervix under magnification and takes necessary biopsies.
In a few cases where there a growth is seen on the cervix, a biopsy is taken for confirmation of cancer. If cervical cancer is confirmed or suspected, the doctor may order further imaging like CT scan, MRI or PET scan.
If the cervical cancer is confirmed, based on clinical and radiological examination, the stage of the cancer is determined. Cervical cancer is staged from (l-IV) depending on the extent it has spread. In the early stages of cervical cancer, surgery is preferred. The surgical procedure is known as radical hysterectomy. With this procedure, the uterus, ovaries and lymph nodes around the uterus are removed.
In the more advanced cases, the treatment is usually a combination of chemotherapy and radiation Surgery is reserved for those specific cases that are not responding to chemotherapy and radiation.
The chances of developing cancer are much higher when the immunity is reduced with conditions such as an HIV infection
- External beam radiation or teletherapy in which the radiation is given from outside.
- Internal beam radiation or brachytherapy in which the radiation is given by placing wires or moulds within the cervix.
A combination of both is usually required for cervical cancer. Chemotherapy alone is given in advanced cases of cervical cancer as a palliative measure.
There are vaccines available which can help prevent women from the HPV infection. Though the vaccine has been associated with a great deal of controversy with regard to the vaccine, the American Cancer Society does recommend giving the vaccine to all girls between the age group of 11-13. Three doses of the vaccine is given over a six months time frame. However, the exact duration of protection is not known. In India, with the lack of clear recommendations, the vaccine has to be given after a discussion of benefits and limitations with the parents of the girl child.